Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 181-190, August 2009

Ketamine and Neurotoxicity: Clinical Perspectives and Implications for Emergency Medicine

  • Steven M. Green, MD

      Affiliations

    • Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA
    • Corresponding Author InformationAddress for correspondence: Steven Green, MD, Loma Linda University Medical Center A-108, 11234 Anderson Street, Loma Linda, CA 92354; 805-969-2144, Fax 775-307-4121
  • ,
  • Charles J. Coté, MD

      Affiliations

    • Department of Anesthesia and Critical Care, Harvard Medical School and MassGeneral Hospital for Children at Massachusetts General Hospital, Boston, MA

Received 9 September 2008; received in revised form 23 September 2008; accepted 1 October 2008. published online 07 November 2008.

Rodent and monkey research has shown that ketamine can induce accelerated programmed nerve cell death (apoptosis) when administered in high doses, for prolonged periods, or both. Concern about similar neurotoxicity with human therapeutic use has prompted ongoing investigations by the Food and Drug Administration and National Institutes of Health. If the results of these inquiries are unfavorable to ketamine, such action could ultimately lead to restricted availability of this drug or even its discontinuation from the market. This article discusses the limitations of the published animal research, the challenges in extrapolating such data to humans, the need for further animal and human investigations, and the potential adverse effect on current clinical practice that might result, should the use of ketamine be restricted or the drug removed from the market.

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 Supervising editors: Michael W. Shannon, MD; Donald M. Yealy, MD

 Dr. Shannon and Dr. Yealy were the supervising editors on this article. Dr. Green did not participate in the editorial review or decision to publish this article.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online November 6, 2008.

 Reprints not available from the authors.

PII: S0196-0644(08)01855-6

doi:10.1016/j.annemergmed.2008.10.003

Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 181-190, August 2009